11D2186854 CLIA NUMBER - ADVANCED UROLOGY INSTITUTE OF GEORGIA, PC

Laboratory Demographics

  • CLIA Code: 11D2186854
  • Facility Name: ADVANCED UROLOGY INSTITUTE OF GEORGIA, PC
  • Facility Address: 2205 RIVERSTONE BOULEVARD SUITE 101
    CANTON, GA
    ZIP 30114
  • Facility Phone: (770) 979-9966
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JASON LOMBOY
  • NPI Number: 1942820576
  • Taxonomy: 208800000X - Urology

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CLIA Record

Field Name Field Value
CLIA Number 11D2186854
LAB Type Physician Office
Facility Name ADVANCED UROLOGY INSTITUTE OF GEORGIA, PC
Street 2205 RIVERSTONE BOULEVARD SUITE 101
City CANTON
State GA
ZIP 30114
Phone 7709799966
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/23/2024
Certificate Expiration Date 6/22/2026
Facility Type Physician Office
Lab Director JASON LOMBOY

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This page was last updated on: 5/18/2026